Healthcare Provider Details

I. General information

NPI: 1790284834
Provider Name (Legal Business Name): MED PSYCH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5163 W WOODMILL DR STE 13
WILMINGTON DE
19808-4067
US

IV. Provider business mailing address

318 ORACLE RD
WILMINGTON DE
19808-1561
US

V. Phone/Fax

Practice location:
  • Phone: 302-660-7200
  • Fax: 302-407-5167
Mailing address:
  • Phone: 302-660-7200
  • Fax: 302-407-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IMRAN TRIMZI
Title or Position: CEO
Credential: MD
Phone: 302-660-7200